A Well-circumscribed Border with Peripheral Doppler Signal in Sonographic Image Distinguishes Epithelioid Trophoblastic Tumor from Other Gestational Trophoblastic Neoplasms

Figure S1. Ultrasound images of 12 ETT cases. Ten out of twelve patients had one detectable uterine lesion in ultrasound images, while Case 10 had two uterine lesions and Case 9 had metastasis lesion in the inguinal lymph node. On gray-scale images, the lesions appeared heterogeneously solid or cystic-solid masses with clear border. On Color Doppler images, the relatively more Doppler signal spots formed by blood flow were distributed at the peripheral tumors, while fewer signal spots were showed within the boundary of tumors, which is named as “peripheral Doppler signal”. Figure S2. Ultrasound images of 21 PSTT cases. Each patient had one detectable uterine lesion in ultrasound images. On gray-scale images, the lesions appeared heterogeneously solid, cystic or cystic-solid masses with unclear border. On Color Doppler images, the Doppler signal presented within the boundary of tumors rather than at the peripheries, which is named as “non-peripheral Doppler signal”. Figure S3. Ultrasound images of 24 IM/CC cases. 16 patients had one detectable uterine lesion, which showed heterogeneously solid or cystic-solid masses with unclear border on gray-scale images, and more Doppler signal spots were distributed within the boundary of tumors, or throughout the whole tumors, which is named as “non-peripheral Doppler signal”. Other 8 cases (Cases 2,3,7,8,10,12,14 and 17) had no detectable lesion in the uterus. Figure S4. Histological images of 12 ETT cases. Cases 1, 5, 7, 10 and 11 were stained with H&E but not immunohistochemistry; Cases 3, 4, 6, 9 and 12 were stained with H&E (left) and p63 (right); Cases 2 and 8 were stained with H&E (left) and hPL (right). H&E staining profile showed an expansile growth pattern with pushing border, and extensive necrosis presented within the boundary. Immunohistochemical staining showed positive nuclear expression of p63 but negative cytoplasmic hPL. Figure S5. Histological images of 21 PSTT cases. Cases 1, 11, 13 and 20 were stained with H&E but not immunohistochemistry; Cases 2-10, 14, 16, 18, 19 and 21 were stained with H&E (left) and hPL (right); Case 12 and 17 were stained with H&E (left) and p63 (right), Case 15 was stained with H&E (left) and CD146 (right). H&E staining profile showed an infiltrating growth pattern with the penetration of tumor cells into the myometrial smooth muscle fibers and blood vessels. Immunohistochemical staining showed positive cytoplasmic hPL and CD146, but negative nuclear p63.